‘Entrenched in his belief:’ Revocation and $251K in costs for former chief of medicine who engaged in ‘campaign of disruption’ to defy hospital’s model of care

A former high-ranking Ontario doctor accused of engaging in a “campaign of disruption” against a revised hospital model of care he disagreed with has been banned from practice and ordered to pay $250,510 to cover the cost of 24 days of college hearings. Dr. Albert Kadri—who was chief of medicine and renal program director at the Windsor Regional Hospital in Windsor, Ont., and regional medical lead for Ontario’s renal network—refused to make policy-mandated clinic referrals, sent orders to the hospital after he lost his privileges, billed and collected fees that should have been paid to other nephrologists, and misled a young physician and his family into moving to Windsor with an offer of hospital employment he did not have the authority to make, according to a decision document issued by the Ontario Physicians and Surgeons Discipline Tribunal. The tribunal—the discipline arm of the College of Physicians and Surgeons of Ontario—found Dr. Kadri incompetent and guilty of professional misconduct, and ordered revocation of his medical certificate as “the only penalty that will protect the public.” “Dr. Kadri is entrenched in his belief of the propriety of his actions,” wrote the tribunal in its penalty decision document. “He has no insight into how his actions impacted not only his patients but also his nephrology colleagues, hospital staff, and a young physician who considered him his mentor.” Dr. Kadri’s certificate of registration with the College of Physicians and Surgeons of Ontario had expired in August 2022 and he did not renew it, according to the decision document filed by the tribunal. He did ask the tribunal, without success, to postpone its decision on penalty pending the outcome of a whistleblower complaint he said he had filed with the Auditor General of Ontario regarding several aspects of the model of care and why it was implemented. Read: Doctor who put non-cancer patient through extensive chemo ordered to pay close to $73K The case against Dr. Kadri dates back to 2018, when the Windsor Regional Hospital suspended his privileges. According to a case document from the Ontario Superior Court of Justice—which had ruled against Dr. Kadri’s appeal to be reinstated at Windsor Regional Hospital—Dr. Kadri had refused to comply with the hospital’s new model of care for patients with chronic kidney disease. Under the new model, care for these patients was shifted to community- or team-based, but Dr. Kadri wanted to retain his role as the most responsible physician for his patients and continued to give orders even when the on-duty nephrologist had already taken responsibility. He also refused to comply with the hospital’s requirement that all nephrologists with privileges refer patients who meet criteria to a multi-care kidney clinic, which would give patients access to a multi-disciplinary team that includes nephrologists and various allied health professionals such as a vascular access nurse, pharmacists, social workers and dietitians. Dr. Kadri said he never scheduled clinical time at the multi-care kidney clinic because this would automatically transfer his patients to the care of the clinic and he would no longer have a say in their care as an individual nephrologist. Another reason he gave for refusing to refer patients to the clinic was a change to the clinic’s criteria he considered more restrictive and which excluded more patients. But the tribunal did not find this reason persuasive because Dr. Kadri was not referring patients even before the clinic changed its criteria. In his final submission during his hearing, Dr. Kadri admitted he “never followed” the new model of care and that he referred only one patient to the kidney clinic. He also admitted that he bypassed the clinic by referring 53 patients directly for vascular access surgical appointments, even though these appointments were supposed to be arranged by the clinic. Read: The challenges of inefficiency in the healthcare system The tribunal also found that Dr. Kadri created confusion by faxing orders to the hospital hemodialysis unit that occasionally conflicted with orders made by the on-call nephrologist. “Dr. Kadri also does not deny that after the revocation of his hospital privileges, he continued to fax orders to the (hospital) for his patients," wrote the tribunal. "He again explained that he was sending information on what he thought needed to be done regarding his patients’ care.” After he learned of the hospital’s decision to suspend his privileges, Dr. Kadri sent a message to all his patients advising them that the hospital has “taken steps to limit the involvement and interaction between you and your nephrologist. I have objected to this as I feel it does not represent best practice and this change was implemented without individual patient consent, leading to confusion in patient expectations. Given that your condition is quite serious, I have been personally advocating against this for more than one year.” The hospital testified in the hearing that it had to send a letter to the recipients of Dr. Kadri’s letter to correct some inaccurate information. Dr. Kadri’s actions had financial consequences as well that worked in his favour while shortchanging other nephrologists at the hospital. Ontario’s health insurance plan provides for a chronic dialysis team fee, payable to the most responsible physician. Under the old model of care at Windsor Regional Hospital, the nephrologists who received the initial patient referral were considered the most responsible physician and captured the weekly chronic dialysis team fee even when they were away when their referred patient came for dialysis and other nephrologists attended to the patient. With the new model, on-call nephrologists were able to bill the chronic dialysis team fee for the times they were on rotation of duty. However, Dr. Kadri continued to bill for this fee even when he was not the nephrologist on call. This led to other nephrologists’ billing getting rejected because Dr. Kadri had already billed for the same service periods, for patients he considered his own. One doctor had about $150,000 in rejected claims between March 2017 and June 2018. Read: Two years in the dark: From 2017 to 2019, doctor ignored tests that pointed to stage 4 cancer According to the decision document, Dr. Kadri tried to evade questions about whether or not, under the new model of care, he had billed the chronic dialysis team fee when not on call. He subsequently conceded that he had billed this fee every week for “his” patients even when he was not on call. “Dr. Kadri further explained that even when not on call, he was ‘available 24/7’ to his patients through multiple means and that he had never taken a vacation in the five years prior to the implementation of the new model,” wrote the tribunal. “He also agreed, however, that while he was always available to his patients, he might not necessarily see or talk to them every week.” By refusing to comply with the billing structure under the new model of care, Dr. Kadri “in effect stole hundreds of thousands of dollars from his colleagues,” added the tribunal. The tribunal also looked at Dr. Kadri’s actions towards an international medical graduate identified in the decision document as Dr. Amin. According to the tribunal, in December 2014, Dr. Kadri offered Dr. Amin a nephrology position, to commence after he had completed his training. In his testimony, Dr. Amin said the job offer was made orally and that he understood he was being offered a position at Windsor Regional Hospital. Dr. Amin also testified that in January 2017, Dr. Kadri presented him with a written offer of employment on Windsor Regional Hospital letterhead. Dr. Amin said he did not know that by this time, Dr. Kadri was no longer chief of medicine and director of the hospital’s renal program—he resigned from the position in June 2015—and that he had been advised by the hospital to tell Dr. Amin and another protégé doctor to not come to Windsor. Dr. Amin also noted that the written offer of employment—which he accepted and signed—was backdated to December 6, 2014. Read: Poaching of staff top concern for Ontario hospitals over new surgical centres: OHA Together with his family, Dr. Amin moved to Windsor in May 2017, where he completed a two-month elective in Dr. Kadri’s clinic. On Dr. Kadri’s advice, he applied for hospital privileges at Windsor General Hospital but was told by the director of medical affairs his application was unlikely to proceed because the hospital had just filled its vacant positions in nephrology. The director also suggested Dr. Amin seek legal advice before applying given the implications of having an application for hospital privileges denied. However, according to Dr. Amin, Dr. Kadri encouraged him to continue with his application, which was subsequently denied. Dr. Kadri also told Dr. Amin, according to the decision document, that he had done everything he could to get him a position at the hospital and depicted the latter as a “big bad wolf.” At the same time, Dr. Kadri encouraged Dr. Amin to send orders to the hospital even though he did not have privileges—actions that the hospital cited later as one of the reasons it denied Dr. Amin’s application for privileges. Dr. Amin subsequently terminated his relationship with Dr. Kadri and left Windsor at the end of 2017. While he was able to secure employment elsewhere, he told the tribunal his career had been set back a couple of years because, believing he already had a position in Windsor, he did not look for other opportunities. In deciding on Dr. Kadri’s professional competence, the tribunal concluded that Dr. Kadri failed to meet the standard of practice by not referring patients to the multi-care kidney clinic, or referring them late in their disease process. The tribunal cited at least one case where Dr. Kadri’s tardiness in referring to the clinic may have contributed to a patient’s death. Yet, “Dr. Kadri continues to view his actions as defensible on the basis that the new model of care was unsafe,” wrote the tribunal. “Even if he honestly holds this belief, it was inappropriate for him to engage in a campaign of disruption regarding care that was being provided to a vulnerable patient population. There is no evidence that remediation is possible or that Dr. Kadri will not engage in the same disruptive behaviour despite our conclusions that his conduct affected patients in a negative way. Given the extent of the misconduct and the absence of any possibility of remediation, the appropriate penalty is revocation of Dr. Kadri’s certificate of registration and a reprimand.” Read: Why solo doctors are here to stay

‘Entrenched in his belief:’ Revocation and $251K in costs for former chief of medicine who engaged in ‘campaign of disruption’ to defy hospital’s model of care

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